Raging Pre-menstrual syndrome (PMS) in Perimenopause

Premenstrual syndrome (PMS) is believed to affect around 60% of women.

And it can really ramp up in perimenopause.

OR maybe even hit you for the first time.

This can be overwhelming, intense, and challenging.

Fluctuating levels of hormones can trigger changes in mood, increase anxiety and feelings of irritation and even rage.

These hormonal changes can also cause symptoms such as bloating, food cravings, headaches, changes in bowel movements, and sore breasts.

In fact, there are so many potential symptoms, it’s impossible to cover them all in one post…

PMS often happens in the week leading up to your period, and for the first few days of bleeding.

However, if you are no longer ovulating, you may also find that you feel worse towards the end of your period as you will no longer be benefitting from the calming effects of progesterone.

Shorter than normal menstrual cycles can also mean that there is less time between your PMS symptoms and they can seem relentless…

On top of all this, you may also be managing family life, work, and the general stresses of a busy life, as well as looking out for ageing parents too.

It is no surprise that for many women this can mean that their own health gets put on the back burner.

The 3 key reasons PMS can increase during perimenopause AND What you can do about it 

  1. Declining levels of progesterone 

  • Progesterone is often the first hormone to decline in perimenopause. When progesterone is low it can reduce the amount of ‘feel good’ messengers (neurotransmitters) that communicate with the nerve cells in your brain. This can lead to symptoms such as; low mood, anxiety and insomnia.
  • If your thyroid is underactive (this is more common in women over 45) and you are not producing enough thyroid hormones, this can also have an adverse effect on your levels of progesterone
  1. Fluctuating levels of oestrogen (and poor clearance of old hormones)

  • Oestrogen is naturally highest in the week leading up to your period but as you go through perimenopause, oestrogen levels can fluctuate wildly. Added to this, if you are not clearing your old hormones effectively the balance of hormones in relation to one another, can lead to sore breasts, bloating, headaches, and fatigue (TOP TIP – we can test for this).
  • Environmental toxins (xenoestrogens) from sources such as plastic containers, bottles, and canned foods can also mimic oestrogen in your body. These can be detrimental to your health and hormones.
  • At the other end of the scale, low levels of oestrogen can also affect your mood and your bone health… as well as stimulate your appetite and increase hot flushes and night sweats. The good news is that eating certain foods/drinks and avoiding others could help alongside targeted supplements.
  1. Inflammation

  • Whether it comes from poor diet and nutrient deficiencies, illness, compromised gut health, food intolerances or chronic stress, inflammation can block your hormones from being able to get where they are needed. It can also interfere with the detoxification of old oestrogen and reduce neurotransmitters (see point no.1).


5 Things you can do to manage your PMS symptoms

  1. If you have not yet reached menopause (12 months without a period), there are certain nutrients and supplements that could help to increase your progesterone levels and improve your symptoms. If you are further along in your menopause transition, don’t worry, there are still dietary and lifestyle interventions that you could use to help you to manage your symptoms. Ensuring you have a nourishing diet containing all essential nutrients, supporting your gut health and managing your blood sugar and insulin levels can often help.
  2. Get your thyroid hormones checked – If you have an underactive thyroid, this could slow everything down in your body and interfere with hormone production. Thyroid issues are especially common in women in midlife which is why I test the majority of women I work with.
  3. Support your gut health – if you are experiencing any gut issues such as bloating, digestive issues, diarrhoea or constipation, or have a history of antibiotic use, consider getting a gut health test. Gut health is a foundation of good health and can also influence your hormone health
  4. Blood sugar and insulin balance – This is another foundation of good health. Consistently elevated levels of blood sugar and insulin can contribute to hormone imbalances. This can also increase your risk of chronic diseases such as cardiovascular disease and type 2 diabetes. Allowing 4-5 hours between meals and eating a diet that had a balance of good quality proteins, healthy fats and fibre can be key to managing this.
  5. Consider supplement support – Once a full health history and assessment have been taken, targeted supplements can sometimes be helpful for managing symptoms. Please be aware that even natural supplements can interact with medications (including HRT) and may not be suitable for certain medical conditions.

Good to know

Some women find that HRT can be helpful.

However, for around 1 in 20 women, taking progesterone as part of an HRT protocol can make them feel worse…

It can cause increased anxiety, very low mood and depression. This could be due to increased levels of stress hormones (we can test for these too) as well as genetics.

However, it is important to know that progesterone needs to be taken if you have a uterus. Progesterone prevents a build-up of the womb lining and helps to protect against endometrial cancer.


Around 3-8% of women experience symptoms that are more extreme, and carry on for longer. This is called Premenstrual dysphoric disorder (PMDD). If you think this could be happening to you, and your life is being adversely affected, please consult with a medical professional.

Book a FREE health review call 

If you want to find out more about testing or how diet and lifestyle could help? You can book a FREE 30-minute menopause symptom and health review call here. Slots are limited